Selling health: A bargain or a rip-off?

Humans, when sick, are a desperate species. We only realize how important it is to be healthy when we are sick. We find ways to recover – fast. This is our weakness and it is being capitalized on – by health advertisements. In Malaysia, just go to any supermarket or shopping complex, there are so many so called health products booths clamoring for our attention.

The salesperson, with her sweetest voice possible, will try to get you to purchase one. If that does not work, the scare tactic is an option. If you are a hard nut to crack, they aim at your soft spot – family. Yes, we fear for our family’s health. In the end, we succumb to the power of effective sales and we have to part with our money.

Health claims of these supplement health products may not be good enough. The marketers realized that people grow more inquisitive by the day. Such claims do not work anymore. A newer game plan is needed. What other ways to make us believe other than providing evidence? Surely, if another person can be healthy, you can too. Experience would be the greatest proof that a product is safe and effective.

These personal claimants are called testimonials. Many would-be consumers have fallen for it, in effect, spending large sums of money to buy the products. The product may really have worked on the person who appeared on the leaflet. But that is for him, and him alone. He or she may have agreed to appear as a promotional tool. A product ambassador.

But, what about those who never really get to experience the so called health benefit of a product? How many percent of product users actually do not experience any beneficial effects as claimed by the product ambassador? How many people actually had side effects instead but chose to remain quiet about it?

Yet, most people place testimonials as equal status as evidence based research works. In reality, it is not. For a start, medical research may cost a few airbuses. Printing claims on a leaflet, tucked inside a nicely packaged traditionally made concoction, would not even cost more than a brand new SUV. Or may be less.

It is no wonder that the price of medicine bought in private practice may send a 24KV shock to a person who is used to being treated in a government facility. And yet, there are some patients, still ungrateful enough, offering to sell off their newly prescribed medicine from a government facility to earn a few more bucks. Could this be one of the factors that the number of diabetes related fatality continue to rise in this country?

Prescription medicine in Malaysia is under the monitoring of the Ministry of Health. In life, we are frequently tested. Medicine too. All medicine have to undergo rigorous four stages testing and pass with flying colors, before they are released into the market. These tests are called clinical trials. Clinical trials aimed to establish the safety and effective profiles of a medicine.

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Supplements

Phase one of a clinical trial characterize the active compound of a medicine. It is usually small scale and done mostly in healthy volunteers. Once the new compound clears Phase one, Phase two of the clinical trial commences. Phase two tests the effectiveness of the new drug on people with the target disease and condition. Short term side effects are continuously monitored.

Phase three studies how the compound behaves in different populations and different dosages. Here, the number of subjects ranged from hundreds to thousands. In Phase four, more subjects or patients are recruited to further establish the safety and effectiveness of the compound in a longer period of time. After passing Phase four, a post market surveillance will continue to monitor the drugs in use in the market.

The whole process may seem simplified, but it takes years, at times, 20 years before a new drug is marketed after phase four. In 2004, the drug Vioxx or Rofecoxib, a painkiller used in arthritis, was removed from the market including Malaysia due to the increased risk of heart attacks and stroke among patients taking it. This action was the effect of the post market surveillance that was carried out.

None of what have been explained earlier occurs in testimonials. Testimonials is almost as good as hear say. No doubt, it provides a hypothesis for testing, but it does not confirm a hypothesis. A lot of scientific explanation is missed in testimonials. What is the pharmacokinetics (the way the body acts on the drug) behind it? Which receptors did it act upon? What could be the feedback mechanism if any? How does the body rid itself of the end product of the drug? What stage of disease is the patient in when taking the drug? Was the patient concurrently taking other medicine? No wonder doctors hardly explain medication to patients – it’s too overwhelming!

In a research, subjects who do not exhibit the wanted effect are documented. Of course, those with side effects (that is why we need consent) are included too. As safety of subjects is a concern, all research projects involving patients will be panelled by an ethics committee before commencing. Whatever the drug does to a patient, it will be documented. An increase in blood pressure? How much? 1 mmHg? 20mmHg? Dry lips? Palpitations? Increase in heart rate? Reduction in white cell count? Reduction in blood sugar level? What machine was used? Is it valid? All these hard outcomes are well documented.

Compare that to a testimony, “I feel better after a month of product ABC”. Or “I used to walk, but now, after taking Product XYZ, I can run”. “I am a diabetic, but after taking capsule X, I feel healthier”. The claims in testimonials are never measured. Some are even dubious. “After drinking coffee ABC, my wife loves me more”. What has a loving wife got to do with drinking coffee?

Have you ever come across a super product? A super product is a health supplement that does it all. It “treats hypertension, prevents diabetes, prevents eczema, prevents stroke…” In a football crazed community like Malaysia, this is a yellow card situation. Better yet, a red card. If only that drug really exist, the hospitals would be empty and the doctors out of job. No wonder that health products companies are making millions by raking in the hard earned cash of the unwary.

One of the reasons that you might be impressed with doctors is the ability of doctors to pronounce medical jargons. No,supercallafrajalistic expialadocious does not count. In fact, most doctors were told and “trained” to simplify medical complexities. The usage of these terms that pretend to be a medical jargon is truly a wolf in sheep’s clothing. Some examples that may appear on health supplements include “…Hunger Stimulation Points…”, “thermogenesis, which convert stored fats into soluble lipids..” and “One of the many natural ingredients is inolitol hexanicontinate.”.

As a public health person, I would never stop saying this to my overweight patients, “There are no other ways to reduce weight other than a proper diet and exercise”. It is an all-or-none law. Yet, people still fall for the “…safe weight lost vitamins..” and “revolutionary way to lose weight without dieting…” advertisements. The before and after pictures that attest to the effectiveness of the product, when examined in detail, further proves the age old adage in weight lost – proper diet and exercise. The products may work as a motivator to fire you up to look for your misplaced jogging shoes – just on time for me to discuss the magic of the mind – placebo effects.

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Placebo effects

There are people who really swear by the book that a health product really works wonders for them. It cannot be denied. The next question is how sure are we that the effect experienced by that person is due to the active compound in the health product? In testing out new drugs, researchers often randomize subjects to the real drugs or the replica version. The latter does not contain any active ingredient but taste as similar as the real ones.

In the end of the study, subjects are analyzed for the desired effects. Certainly, there are a number of subjects receiving the replica drugs who claimed to experience the intended outcome. This is what we called as placebo effects. Intended effects which are not truly caused by the active ingredient, but by the control of the mind. Could it be that consumers of health products are a victim of this placebo effects?

Is natural really that safe?

We all love nature. Once in the while we would escape from our hectic environment to spend time with nature. Nature refreshes our eyes with greens, and ventilate our lungs with fresh, crisp air. Yes, spending time in nature is good. Most of the time, this context is wrongly used in the promotion of health supplements. Traditional based health supplements usually contain extracts from the roots (e.g. Tongkat Ali roots), barks or even the flower of the plant.

These extracts contains chemical in them – the active ingredient – that makes the drugs, excuse me, health supplements efficacious or effective. This surely contradicts the notion of most naturalists who would say that herbal products are natural and contain no chemical. What the public forgets is that, naturally sourced supplements or synthetically made prescription drugs strong enough to create the intended effects, are surely strong enough to cause side effects.

At times, some health supplements under the pretext of natural traditional products are adulterated to enhance its effectiveness. In this part of the world, virility is vanity. Coffee products are often the favourite vehicle for adulteration with sildenafil, which is the main ingredient in Viagra. Sildenafil, a prescription drug, is a group B schedule poison in Malaysia. Obviously, chemicals are added to give the intended effects – in this case, erection. Pity those who think that they finally ‘got it’ in a safe and natural way.

This article is not going to change the world overnight. Again, if you are not sure of a particular health supplement (here we go again), please check with your doctor. Click on to http://portal.bpfk.gov.my/ to find out if a health supplement is registered or not. -- http://www.mmgazette.com/

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* Dr. Helmy Hazmi is a community medicine specialist with a major in Epidemiology and Biostatistics in Science. He is currently working in his hometown, Kuching, as a medical lecturer. * This article was first published on www.mmgazette.com ** The Malaysian Medical Gazette is an online hub under The Malaysian Integrated Medical Professionals Association (MIMPA) for medical professionals to share their knowledge and experience regarding current issues and common problems on healthcare with the community in an easily accessible and reliable platform. *** The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of Astro AWANI.